On this episode of Fat and Fertile, we explore the ideas that fertility treatment is more risky and less effective for fat folks.

We dive into where these ideas come from, why they are rooted in anti-fat bias and how you can use the research to advocate for your care.

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Hey loves, welcome back to Fat and Fertile the podcast. It’s been a wee while since I recorded the last one as we’ve had one bug after another in our house and I’m not yet a podcast pro who has all their episodes recorded months in advance.

I’m super excited to talk about the myths around fertility treatment for fat folks today, mainly because it can be so bloody difficult for folks to access fertility treatment when they need it.

It’s really important that we recognise that folks of all different types of bodies will need to access fertility treatment. It’s far from the case that all fat folks need IVF but it is the case that it’s a lot more difficult for fat folks to access IVF and that is a big problem!

One of the main reasons why many clinics deny access to IVF and other fertility treatments is that it’s risky to do on fat people and it’s not as effective.

First let’s explore the big question – WHY! Why are fat folks told that IVF is more risky and not as effective for them?

Let’s start with efficacy or how well IVF will work for folks in bigger bodies- There is a divide within the research around IVF for folks with higher weights. The first camp of research shows that as BMI increases the likelihood that IVF or other fertility treatments will work decreases. In these studies, everyone is given the exact same medicine protocol at the same times and yes, when we treat a population of people the same way, IVF and other treatments are less effective for fat folks.

The second camp of researchers treat the subjects of their studies as individuals. What happens then, is that they can modify the treatment protocol based on how they are responding. The results of this is that generally (but not for everyone) fat folks need higher doses of medication but when they are given those doses then the outcomes of the treatment are the same.

IVF procedures and protocols were created and tested on small bodies. They are taught to doctors and surgeons using small bodies as the norm. It makes total sense that when we treat fat people in the same way as thinner folks and expect them to respond in the same way – that we don’t get the same result.

It is not your body’s fault that it may respond differently through treatment to what your doctor expects – it’s the anti-fat bias that is built into our healthcare system.

It’s not inherently a bad thing that you body may need higher doses of medication in order to achieve the same result. We accept this as normal practice in children’s medicine, that we need to give a higher dose based on weight, so why isn’t this a normal practice in healthcare?

Now let’s talk about safety. In order to be able to fully consent to any kind of medical treatment, you need to be aware of the risks and benefits to you. So let’s explore what those risks really are so that you can decide if treatment is an option you might want to pursue.

The main risk given as to why fat people can’t have IVF is a potential risk with anaesthesia. Clinics claim that the risk of complication is too great. This is especially true for stand alone clinics that aren’t attached to a hospital.

The problem is that the main study that looks at BMI and complications doing egg retrieval (which is the part of the procedure in IVF that requires you to have an anaesthesia) shows that there is no increased risk of major complications for folks in the highest BMI category and only a slight increase in minor complications. I’ll link to the study in the show notes if you’d like to print it out and take it with you when advocating for care.

A much bigger study that looked at all BMI’s undergoing egg retrieval showed that the things that impacted outcome the most is surgery time and surgeon competancy.

The way that fat folks are excluded from the development of fertility treatments can explain some of why treatments are seen to be less safe. After all, if you are not taught how to perform treatment on a bigger body and you never practice on bigger bodies, you are going to be less confident and less competent.

Clinics routinely exclude fat bodies so the majority of doctors never learn how to safely perform these procedures on fat people

The most ridiculous thing about this is that in the same breath of denying you treatment based on anaesthetic risk is that they will recommend weight loss surgery which requires the exact same anaesthetic.

Other risks that you might hear talked about are:

  • OHSS (ovarian hyperstimulation shock syndrome) which has actually been shown to occur less often in fat folks when compared to folks in smaller bodies
  • Ectopic pregnancy with no evidence to show this occurs at higher rates in fat folks
  • Blood clots – again no evidence to show that this is more likely to occur in fat people

The way that clinics refuse care from fat folks takes away their ability to make an informed decision about their healthcare is not acceptable.

It should be your decision to make around whether any risks are worth the potential benefit of growing your family.

It is important that you are fully aware of all the risks when you undergo any type of medical procedure but when we look at the evidence there is nothing substantial that shows that fertility treatment is inherently more risky for fat people and that is should therefore be denied to them on this basis.

You deserve access to the same fertility treatments as anyone else.

The two other main reasons that you might be denied fertility treatments are around pregnancy risks which we are going to cover in a future episode and that weight loss is effective which we covered in episode 2.

If you are struggling to find a clinic to support you, I’ve got an ever growing list on my website of clinics that others fat folks have recommended. It’s a good place to get started.

If you want more information on this topic alongside a complete research resource, then I recommend enrolling in my IVF and IUI for Fat Folks workshop. I’ll share the link in the show notes